CN107548497A - Adapted treatments management system with Workflow Management engine - Google Patents

Abstract

The disclosure relates generally to Case management system, and it can include being used for the clinical database for storing treatment agreement.The system can also include the treatment engine for being operatively coupled to clinical database.Treatment engine can be based on acquisition diagnostic message and obtains diagnostic message from clinical database with reference to protocol data and selects more than first to treat agreements.The treatment curative effect probability that each agreement is calculated with reference to protocol data can be used by treating engine.Treatment engine can formulate the first treatment plan and assess the intermediate data for the patient's states that instruction changes due to the first treatment plan.Agreement the second treatment plan of selection can be treated based on being planted with reference to protocol data and adaptability protocol data using more than second by treating engine.Based on clinical target, with reference to protocol data and treatment efficacy information come to selected the second treatment plan progress accommodation.

Description

Adapted treatments management system with Workflow Management engine

The cross reference of related application

The priority for No. 62/131,102 U.S. Provisional Application that patent application claims are submitted on March 10th, 2015 Interests, the entire disclosure of which are incorporated herein by reference.

Technical field

The disclosure relates generally to treatment of cancer management system, and more particularly, to a kind of adapted treatments management System, it provides independent treatment modeling, delivering and assessed, and including Workflow Management engine.

Background technology

It is thin that the successful treatment requirement of human cancer removes cancer while the healthy cell in making surrounding tissue escapes injury Born of the same parents.For example, radiotherapy and other various treatment systems and treatment are used in such as external beam treatment, brachytherapy and art In treating cancer.Radiotherapy treatment of cancer can be promoted by one or more Case management systems.Radiation therapy treatment Management system can be various treatment tasks (such as diagnosis, treatment plan, monitoring and the record preservation being included in particular treatment And other) workflow plan and support are provided.Some systems provide the workflow plan of partial automation.

Over the course for the treatment of, medical professional may possess the various systems and equipment disposed for them, for treating Various ill anatomical structures.Each corresponding system can provide to (such as prostate, mammary gland, incidence, lung, In intestines and stomach and reproductive anatomy etc.) targeted therapies of particular cancers.

In view of the various treatment options of specific cases, the clinical method of integration may include to study various treatment methods (for example, Such as selected between electronics, photon, heavy ion, brachytherapy), and it is more every kind of it is possible treatment option or It is combined, to determine one or more treatment agreements.Various systems can with processing data collection with create select planning therefrom or The candidate therapeutic plan of the combination of plan.For example, after many candidate therapeutic plans are investigated, doctor can determine the group of plan (such as brachytherapy+external beam radiation therapy) is closed to be suitable for treating particular cancers.As another example, doctor It can analyze and compare many different possibility agreements of brachytherapy.Therefore, using the clinical method of integration, doctor Therapeutic purpose can be identified, formulates treatment plan, delivery schedule, the executive plan during radiotherapy portioning is treated, and be directed to mesh Intermediate result is collected and explained to mark.In view of target and after considering intermediate result, doctor can be then based in therapeutic process In be made available by substantial amounts of adapting dynamically to property of machine driving data adjustment treatment plan.Such dynamically adapting is in treatment phase Between can possibly even occur in real time.

Although common practice is retained on treatment decision and the key message of clinical treatment in itself, do not have also currently Keep the intermediate result of various candidate therapeutic options and the lasting record of forecast analysis considered according to intermediate result.It is moreover, logical The comparison that thousands for the treatment of factor is carried out while candidate therapeutic option is selected is crossed (such as using special data mining With information management algorithm) so that the degree of quantitative analysis medical data, can be by for planning that treating the information determined is stored in In one or more independences and the system and database of separation.For example, medical image can be stored in PACS, laboratory result It is stored in HIS, it is medium that treatment plan is stored in TPS.In addition, source data may not be stored (for example, machine with significant form Device readable format and/or third party's proprietary format), and source data is dispersed in many different systems.Machine readable format It can not be explained or performed by people, and the heterologous systems comprising source block are without the ability integrated.Multi-form and shortage one The data of cause may weaken the following overall validity determined on patient's Case management.In addition, determined for making treatment Analysis result in itself not with treatment determine together be recorded.When various medical professionals are in different time different location When carrying out each scheme for the treatment of plan, these factors will be exaggerated.

Many medical treatment devices produce the digital clinical data for being largely used to treatment plan and delivering.These equipment include various Imaging pattern (CT, MR, PET, SPECT, X ray, ultrasound), segmenting system, treatment planning systems, hospital and laboratory information system System, PACS system and treatment delivery system.Central management is provided currently without the medical data that can be generated for various computers System, also without can provide to the field assays of data to determine whether specific treatment should continue or adaptability is adjusted The system of whole (adapted).Furthermore, it is necessary to a kind of can be each during automatic record data analysis during particular treatment The medical computing system of step.Medical computing system can also provide the comparison for the treatment of option, so as to during particular treatment The record of each step can be accessed and be re-used for continue or new treatment, or alternatively, for retrospective analysis. In addition, in the absence of that can create based on the prediction of customization with the medical computing system of successful numerous treatment plans, wherein predicting Based on patient is specific, the specific and substantial amounts of patient information of case is made.Finally, in the absence of being configured as will not mistake Point ground, which is presented in the case of too many data, to be presented these to practitioner with understandable form in real time and a variety of controls Treat the medical computing system of plan.

Accordingly, there exist the needs to adaptability treatment of cancer management, the different information source of many of which, which is integrated into, to be had In the system of flexible treatment plan (such as in real time or offline).Additionally, there are for can be when obtaining data from information Source learns to improve the needs of the adaptive system of the quality by the future therapeutic of system recommendations.

The content of the invention

The disclosure relates generally to Case management system, more particularly relates to produce controlling for offer individual treatment modeling The adapted treatments management system of plan is treated, and it includes Workflow Management engine.In one embodiment, describe including For the system for the clinical database for storing treatment agreement.Each treatment agreement can reflect multiple treatment tasks.The system is also The treatment engine for being operatively coupled to clinical database can be included.Treatment engine can include being configured as obtaining diagnostic message Medical treatment device controller, and be programmed to from the clinical database at least one of more than first treatment agreements of selection Processor.Selection can be based on acquired diagnostic message and with reference to protocol data, wherein including renewal with reference to protocol data Treat efficacy information.Treatment engine can calculate each agreement in more than first treatment agreement using with reference to protocol data Treatment curative effect probability.Treating engine can be based on clinical target, with reference to protocol data and treatment curative effect probability from more than first Treat agreement and formulate the first treatment plan, instruction is assessed during the first treatment plan is performed due to the first treatment plan Implementation procedure and the intermediate data of patient's states changed, and based on using the with reference to protocol data and adaptability protocol data More than two treatment agreement selects the second treatment plan.Based on clinical target, with reference to protocol data and treatment efficacy information to selected The second treatment plan selected carries out accommodation.

In another embodiment, the computer implemented method for producing treatment plan is described.This method can be with More than first treatment agreements are selected from clinical database including the use of at least one processor.The selection can be based on correlation Diagnostic message and with reference to protocol data.Include the treatment efficacy information of renewal with reference to protocol data.Methods described can also include The clinical target for the treatment of plan is determined using at least one processor, is used using at least one processor and refers to agreement Data calculate the treatment curative effect probability of each agreement in more than first treatment agreements, and clinic is based on using at least one processor Target, with reference to protocol data and treatment curative effect probability formulate the first treatment plans from more than first treatment agreements.This method can be with Further comprise：During the first treatment plan is performed intermediate data, the centre are assessed using at least one processor The patient's states that data instruction changes due to the implementation procedure of the first treatment plan；And based on reference protocol data and fit Answering property protocol data selects the second treatment plan using more than second treatment agreements.Clinical target can be based on, with reference to agreement Data, new diagnostic message and treatment efficacy information carry out accommodation to the second selected treatment plan.

After each treatment portioning of delivering, can use in an identical manner one or more images, dosimetry and Bio-absorbable data and/or other diagnostic messages for being collected during treatment portioning before apply this method.This method pair The patient for starting additional courses is also suitable.

It should be appreciated that overall description and following embodiment above is only exemplary and explanat, without It is the limitation to the disclosed embodiments claimed.

Brief description of the drawings

It is merged in the disclosure and forms the accompanying drawing of a part of this disclosure and shows exemplary embodiment, and and specification It is used to illustrate disclosed principle together.

Fig. 1 shows current radiotherapy decision process；

Fig. 2 is the block diagram according to the exemplary adaptive radiation therapy Case management system of some embodiments of the present disclosure；

Fig. 3 is the block diagram acted on behalf of according to the exemplary treatment of some embodiments of the present disclosure；

Fig. 4 is the functional block according to the exemplary adaptive radiation therapy Case management system of some embodiments of the present disclosure Figure；

Fig. 5 is the flow for showing the illustrative methods for adaptability treatment of cancer according to some embodiments of the present disclosure Figure.

Fig. 6 is the block diagram according to the exemplary adaptive radiotherapy case database of some embodiments of the present disclosure；

Fig. 7 is the block diagram according to the exemplary adaptive radiotherapy protocol database of some embodiments of the present disclosure；

Fig. 8 is the block diagram according to the exemplary adaptive radiotherapy assignment database of some embodiments of the present disclosure；

Fig. 9 is to show the illustrative methods for being used to select more than first individual clinical protocols according to some embodiments of the present disclosure Flow chart；

Figure 10 is to show the flow for being used to assess the illustrative methods of intermediate data according to some embodiments of the present disclosure Figure；

Figure 11 is to show the exemplary side for being used to select more than second individual clinical protocols according to some embodiments of the present disclosure The flow chart of method；

Figure 12 is the flow chart for showing to be treated according to the adaptive radiation therapy of some embodiments of the present disclosure；

Figure 13 is the flow chart for showing the adaptive radiation therapy treatment plan according to some embodiments of the present disclosure；

Figure 14 is the flow chart for showing the adaptive radiation therapy Case management agreement according to some embodiments of the present disclosure.

Embodiment

Exemplary embodiment is described with reference to the drawings.In the accompanying drawings, the leftmost numeral of reference represents wherein accompanying drawing Mark the accompanying drawing occurred first.At convenience, referred in all of the figs using identical reference same or analogous Part.Although this document describes the example of disclosed principle and feature, the spirit and model of disclosed embodiment are not being departed from In the case of enclosing, can modify, accommodation and other realization.It is described in detail below be to be considered only as it is exemplary, Its true scope and spirit are indicated by appended claims.

Currently, medical professional uses the treatment plan and delivery system developed from various autonomous systems.Each Corresponding system can be disposed with the linear work stream with the high integration of its environment.For example, provided in radiotherapy more In the clinical practice of individual treatment portioning, the information of the acquistion in prior treatment portioning can be analyzed to optimize successive treatment portioning. Fig. 1 depicts the current linear workflow (such as radiotherapy decision process) in advanced clinical setting, as described below, Wherein medical professional by from the information integration of prior treatment acquistion to particular treatment (for example, Current therapeutic portioning) and by In the application for the new clinical target that workflow determines.

Referring now to Figure 1, medical professional 102 can formulate the clinical target in treating cancer patient's (not shown) 101.Clinical target or therapeutic purpose can be based on from dependent on concurrency (for example, given time point sequentially and/or Multiple different activities of the same snapshot of patient information are sequentially connected to, for example, a case) the clinic collected of workflow Information 103.For example, clinical information 103 can include the data collected from the currently active treatment portioning, such as by one or more The data that more image therapeutic systems are collected are (for example, display jeopardizes the profile of organ (OAR) and the picture number of targeted treatment location According to).Over the course for the treatment of, medical professional 102 can analyze intermediate result, and compile available choosing based on current data .Such intermediate result can include such as multi-modality images (CT, MR, PET, MV, KV, US), the dosage delivered so far, reality Test room result, patient vital sign and biological effect measurement.Based on available clinical information 103 and patient medical history 104 and other 105 are determined to make initial treatment.Clinical information 103 is additionally may included in analyze data and selects the prediction point in clinical treatment Analysis (for example, the analysis performed by special computing system, such as utilize intelligent algorithm).Determined making initial treatment 105 and after delivering clinical treatment 106, it is contemplated that the prediction of patient and/or the reaction observed may be needed repeatedly Treatment.For example, repetitive therapy portioning is probably clinically to need, and can be prescribed by medical professional 02, its In the middle portioning using prior treatment the information (for example, medical history 104A) of acquistion come optimize future treatment portioning.

In adaptive radiotherapy environment, medical professional 02 can be based on new available average information and redefine Clinical target is to create new clinical target 107.For example, image-forming information can indicate that tumour is not responsive to the first clinical treatment 106 (for example, outputing the amount of radiation of prescription based on treatment portioning, tumour could not reduce).In another example, laboratory and life Life sign information can indicate the generation (for example, jeopardizing organ has negatively reaction) of the undesirable side effect for the treatment of 106.System A fixed reason to the adaptation method of radiotherapy be keep treatment for tumor vicinity and around healthy organ and The short-term and long-term undesirable treatment side effect of tissue is while acceptable level, by increasing the therapeutic dose to tumour To improve the possibility of tumour control.

For accommodation to new treatment, in the case of with one or more new clinical targets 107, medical treatment Professional 102 can open new path (sub- case).Although it may be included now in the medical history 104B of this treatment stage Initial treatment determines the clinical treatment 106 of 105 and delivering, and in current practice, the various numbers for determining 105 are treated for reaching It can be stored in the medical system of various computer drives according to body and clinical information 103.Because multiple systems may exist It is previously used for compiling clinical information 103, as time goes by, possibly can not be maintained in the planning that initial treatment determines 105 The significant lasting record of the clinical information 103 used is (for example, without overall case view, wherein it is presented in (son) system The isolated data of oneself).In addition, determine that the process of particular treatment at least in part may be by medical professional 102 in view of facing The personal knowledge and experience of bed information 103 drive, to the clinical information 103 without the significant record of establishment.Do not facing In the case of bed information 103, medical professional 102 may not benefit from the record of analytical procedure.In other words, analyzing The process of original case and new treatment to new case determine not creating useful link between 111 derivation.Therefore, face Bed treatment 112 can lack some previous important informations and before analysis in the case of deliver, when making new treatment When determining 111, previous important information and former analysis should may have been applied to medical professional 110.

The shortcomings that existing radiotherapy Workflow Management System, comes from the system architecture for the product previously formulated, the system tray Structure is not designed according to requirement on flexibility caused by the plan adaptability needed for adaptive radiotherapy.Therefore, it is used for The old framework of compilation clinical information 103 result in increasingly complicated radiotherapy Design of Workflow System, and these designs may incline To in bringing associated formulation, deployment and maintenance issues to them, (if for example, introducing new data type, pressure is The reliability of existing capability is rebuild or changed to system).When treatment plan various aspects by different medical professionals 110 simultaneously (for example, being that Current therapeutic plan is made decision), different time (for example, being that future therapeutic plan is made decision), and/or not With position (for example, the treatment that the possibility provided at diverse location occurs for Current therapeutic plan or future therapeutic portioning Portioning) perform when, these factors are often exaggerated.Although the second medical professional 110 can access the medical history 104C of patient, But determined just with available data and available treatment option to carry out new treatment, and be not benefit from being used to formulate previously Treatment determine previous clinical information, reasoning and analysis.With regard to this available degree of former information, compilation and analysis are first Preceding information is possibly can not be based on current radiotherapy Workflow system and product come practical.

Embodiment described herein the adaptability tune that the on-line planning integrated can be provided for clinical radiotherapy workflow Whole, concurrency and flexible data management.Source is applied to clinical data and the lasting record of data analysis by embodiment, its Available for the quality assurance for meeting standardized therapeutic agreement, increase useful in same and/or similar patient future therapeutic Clinical information, and coordinate the workflow of different time and/or position.

The exemplary embodiment of the disclosure is described below.Referring now to Fig. 2, according to some embodiments of the present disclosure, description Exemplary adaptive radiation therapy Case management system 200 (hereinafter referred to as " system 200 ").System 200 can be configured as Adaptive radiotherapy is provided to cancer patient (such as clinical person under inspection 218).For example, system 200 can be configured as putting Penetrate in treatment clinic and support and perform diagnosis, treatment plan, treatment delivering and data management.

System 200 can include treatment proxy module 210, its can be connected with via communication network 220 or more More other treatment proxy module (for example, 222,224 and 226) is operatively connected.Treatment proxy module 210 is operably connected To clinical person under inspection 218.Treatment proxy module 210 can include adapted treatments engine 212 and one or more clinical datas Storehouse 214.System 200 can also include the one or more clinical databases 216 being connected with communication network 220.

Treatment proxy module 210 can be configured with adapted treatments engine 212 and clinical database 214 to provide Adaptive radiotherapy.For example, in some versions, treatment proxy module 210 can be configured as connecing from clinical person under inspection 218 Data are received, it can include one or more medical treatment devices (for example, medical treatment device 309 and 310 as shown in Figure 3).Treat generation Reason module 210 can be additionally configured to by information and known treatment agreement, treatment task and be stored in clinical database 214, Other information in clinical database 216 and/or other data sources is associated, and uses the related letter in the treatment of patient Breath.Relevant information can be retained in clinical database 214 by treatment proxy module 210.In addition, treatment proxy module 210 can So that including data management system, it includes adapted treatments engine 212 and one or more clinical databases 214, clinical data Storehouse 214 includes patient data, standardization radiotherapy protocol library and the treatment task library with agreement various aspects cross-correlation.

Treatment proxy module 210 can handle the diagnostic message from clinical person under inspection 218 during patient is treated, such as The one or more of medical images (for example, CT, MR, PET, SPECT, X ray, ultrasound etc.) obtained by imaging medical treatment device, and And (multiple) medical image is saved in one or more records in clinical database 214.Treating proxy module 210 can be from Clinical database 214 obtains (multiple) medical image, analyzes (multiple) medical image and based on to (multiple) medical image Analysis selects multiple treatment agreements from clinical database.Analysis for example can include the full empty measure of bladder, intestines gas detects, Primary tumor site shrink and retraction of organs and other.The treatment agreement discussed in more detail further below can be based on (multiple) Medical image and other information such as the reference protocol data of the model formula (recipe) of radiotherapy select.

Treating the selection that proxy module 210 performs can be based on by processor (for example, accelerating treatment unit (APU) or mixed Close CPU/GPU processors, processor 302 as described below etc.) calculating of any given quantity that performs is (for example, thousands of, hundreds of Ten thousand or billions of calculating).In some versions, treatment proxy module 210 can be configured as being based on from clinical person under inspection 218 The large data sets obtained with clinical database 214, to hundreds of predictions that may be treated option and perform particular treatment response.According to Some embodiments, treatment proxy module 210 can be configured as formulating the first treatment plans from multiple treatment agreements, and the During the simulation delivering of one treatment plan, the intermediate data of the image for including obtaining and the dosage calculated is assessed.The assessment can be with Indicate the patient's states changed caused by the simulation implementation procedure of the first treatment plan, as a result, based on reference to agreement number According to adaptability protocol data the second treatment plan is selected using more than second treatment agreements.

Treatment proxy module 210 can be physically located in using preservation on treatment proxy module 210 or facing near it Information on bed database 214 provides adaptive radiation therapy to clinical person under inspection 218.According to other embodiment, treatment agency Module 210 can be used and be stored in information on clinical database 216, and it can be located locally in same clinic or remotely It can be accessed positioned at another location and by network (for example, communication network 220).Treat proxy module 210 can with positioned at phase With room in, in same clinic or be remotely located at other treatment proxy modules 222,224 and/or 226 of another location Associated working.Treatment proxy module 222,224 and 226 can be shared in one or more common clinical databases (for example, facing Bed database 216) in information and/or each in its respective local data base on keep the local of clinical database Copy (for example, on treating the 214 of proxy module 210).According to other exemplary embodiments, clinical database 214 can be by It is configured to retain one or more redundant storages in the database that any other is operatively connected.Therefore, in treatment portioning In the case of the connection failure that remote position data storehouse is arrived during process, adapted treatments engine 212 can be from clinical database 214 access the local replica of information needed, to maintain the integrality of ongoing clinical treatment.

Fig. 3 is the block diagram for realizing the exemplary treatment proxy module 210 of the embodiment consistent with the disclosure.Treat generation The modification of reason module 210 can be used for realizing one or more medical treatment devices (for example, medical treatment device 416,418 and shown in Fig. 4 420), medical treatment device interface 420 and/or servicing unit 415.For example, medical treatment device can include such as imaging device, imaging dress Put including the imaging sensor of the image for capturing patient and for implementing treatment (for example, radiotherapy dosage) to patient Treatment delivery apparatus.Further relate to Fig. 4 and medical treatment device is discussed.Treatment proxy module 210 can include (the example of processor 302 Such as, CPU (" CPU "), graphics processing unit (" GPU "), application specific integrated circuit (" ASIC ") etc.).Processor 302 It can include being used to perform computer-executable program instructions, perform computer program component, execution user request or system life Into request at least one data processor.User can be including the use of the people of medical treatment device, for example, medical professional 424 (for example, doctor, nurse, therapist, medical technician, radiologist, oncologist or any medical training of process Anyone).Processor 302 can include such as integration system (bus) controller, memory management control unit, floating-point list The specialized processing units of member, graphics processing unit, digital signal processing unit etc..Processor 302 can include microprocessor, all Application program, embedded or safe processor, IBM PowerPC such as AMD Athlon, Duron or Opteron, ARM, Intel Core, Itanium, Xeon, Celeron or other processor familys etc..Processor 302 can use main frame, distribution Formula processor, multinuclear, parallel, grid or other frameworks are realized.Some embodiments can utilize such as application specific integrated circuit (ASIC), the embedded skill of digital signal processor (DSP), field programmable gate array (FPGA), on-chip system (SoC) etc. Art.

Processor 302 can be arranged to via I/O interfaces 303 to be led to one or more input/output (I/O) device Letter.I/O interfaces 303 can use communication means and/or agreement (it is different from medical protocol as described herein), such as but unlimited In audio, simulation, numeral, monophonic, RCA, stereo, IEEE-1394, universal serial bus, USB (USB), infrared Line, PS/2, BNC, coaxial module combined type digital visual interface (DVI), high resolution multimedia interface (HDMI), radio frequency day Line, S-Video, VGA, IEEE 802.11a/b/g/n/x, bluetooth, honeycomb (such as CDMA (CDMA), high-speed packet access (HSPA+), global system for mobile communications (GSM), Long Term Evolution (LTE), WiMax etc.) etc..

Treatment proxy module 210 can be communicated using I/O interfaces 303 with one or more I/O equipment.It is for example, defeated Keyboard, mouse, control stick, camera, barcode reader, softdog, biometric reader, wheat can be included by entering equipment 304 Gram wind, touch-screen, touch pad, trace ball, sensor (such as accelerometer, optical sensor, RF detectors, gyroscope, close to passing Sensor etc.), contact pilotage, scanner, storage device, transceiver, video-unit/source etc.

Input equipment 304 can also be one or more medical treatment devices, such as medical treatment device 416,418 and/or 420 is (such as Shown in Fig. 4).As described above, medical treatment device 416,418 and/or 420 can be brachytherapy system, afterloading unit (afterloader), linear accelerator, the magnetic resonance scanner that is combined with linear accelerator or other treatment medical system.

Output equipment 305 can be printer, facsimile machine, video display, audio tweeter etc..In some embodiments In, transceiver 306 can be arranged to be connected with processor 302.Transceiver 306 can promote it is various types of be wirelessly transferred or Receive.For example, transceiver 306 can include being operatively coupled to transponder chip (for example, Texas Instruments (Texas Instruments WiLink WL1283), the BCM4750IUB8 of Broadcom companies, Infineon (Infineon) science and technology are public X-Gold618-PMB9800 of department etc.) antenna, there is provided IEEE 802.11a/b/g/n, bluetooth, FM, global positioning system (GPS), 2G/3G HSDPA HSUPA communications etc..

In certain embodiments, processor 302 can be arranged to communicate with communication network 220 via network interface 307. Network interface 307 can communicate with communication network 220.Network interface can use connection protocol, including but not limited to directly connect Connect, Ethernet (such as twisted-pair feeder 10/100/1000Base T-ports), transmission control protocol/Internet protocol (TCP/IP), order Board ring, IEEE 802.11a/b/g/n/x etc..Communication network 220 can include but is not limited to direct interconnection, LAN (LAN), Wide area network (WAN), wireless network (such as using WAP), internet etc..Use network interface 307 and communication network 220, treatment proxy module 210 can communicate with device 309 and 310, and/or with treatment agency 311.As shown in figure 3, these are filled (one or several) personal computer, (one or several) server, such as honeycomb can be included but is not limited to by putting 309 and 310 Phone, smart phone (for example, the iPhone of Apple Inc., blackberry, blueberry, phone based on Android system etc.) various mobile devices, Tablet personal computer, portable computer, notebook computer, handheld medical device etc..In certain embodiments, proxy module 210 is treated It itself can embody or be stored on one or more in these devices 309 or 310.

In certain embodiments, processor 302 can be via memory interface 312 and one or more storage arrangement (examples Such as, RAM 313, ROM 314 etc.) communication.Storage arrangement can include memory 315 (for example, non-transitory is computer-readable Medium) it is configured as storage and treatment use data 320, clinical database 214, adapted treatments engine 212, user interface 317 and operating system 316 in one or more associated data or information (for example, program).Memory interface 312 can also It is arranged to using such as Serial Advanced Technology Attachment (SATA), integrates drive electronics (IDE), IEEE-1394, general string The connection protocols such as row bus (USB), optical-fibre channel, small-sized treatment proxy module interface (SCSI), network attached storage, iSCSI It is connected with other equipment, other equipment includes but is not limited to one or more external data bases of such as clinical database 216, deposited Memory drive, removable disk drive etc..Storage device or can also alternatively include magnetic drum, disc driver, magnetic It is one or more in CD-ROM driver, CD-ROM drive, redundant array of independent disks (RAID), solid-state storage device, solid-state drive etc..Deposit The modification of reservoir device can be used for realizing such as clinical database 214 and other databases discussed below (such as clinical data Storehouse 216, case database 600, protocol database 700 and assignment database 800).In one embodiment, storage arrangement can With including random access memory (RAM), static RAM (SRAM), Synchronous Dynamic Random Access Memory (SDRAM), double data rate SDRAM (for example, DDR3 and specify the memory for supporting the standards of DDR3 1333, etc.) and Rambus DRAM(RDRAM).Storage arrangement can construct in many ways, for example, as single in-line memory mould Block, dual-inline memory module or detachable RAM memory etc..Using such storage arrangement spy can be come to store Determine the diagnostic message of patient, such as medical image and two or more treatment plans, these are obtained to reduce from database The quantity of data, so as to accelerate the operation of process described herein.

Storage arrangement can be with the set of storage program or database component, and it can relate to, but are not limited to adapted treatments Engine 212, clinical database 214, operating system 316, user interface 317 and treatment use data 320 are (for example, in the disclosure Any data variable or data record discussed) etc..Operating system 316 can promote to treat the resource management of proxy module 210 And operation.The example of operating system includes but is not limited to Apple Macintosh OS X, Unix, Unix class system distribution version (for example, Berkeley Software Distribution (BSD), FreeBSD, NetBSD, OpenBSD etc.), Linux are issued Version (such as Red Hat, Ubuntu, Kubuntu), IBM OS/2, Microsoft Windows (XP, Vista/7/8 etc.), Apple iOS, Google Android, Blackberry OS etc..User interface 317 can pass through text or graphical tool (example Such as, graphic user interface) promote the display of program assembly, execution, interaction, manipulation or operation.For example, user interface can be Be operatively coupled in the display system for the treatment of proxy module 210 provide computer interactive interface element (such as cursor, icon, Check box, menu, scroll bar, window, widget etc.).Graphic user interface (GUI) can be used, and can be included for example But be not limited to Apple Macintoshes Aqua, IBM OS/2, Microsoft Windows (for example, Aero, Metro etc.), Unix X-Windows, web interface storehouse (for example, ActiveX, Java, JavaScript, AJAX, HTML, Adobe Flash etc.) etc..

According to some embodiments, treatment proxy module 210 can realize that the program assembly of web browser storage (does not show Go out).Web browser can be that hypertext checks application program, such as Microsoft Internet Explorer, Google Chrome, Mozilla Firefox, Apple Safari or offer allow to check any of hypertext to the connection of internet Software application.HTTPS (Secure Hypertext Transfer Protocol), security socket layer (SSL), Transport Layer Security can be used (TLS) web page browsing of offer safety such as.For example, web browser can utilize such as AJAX, DHTML, Adobe Flash, The instruments such as JavaScript, Java, application programming interface (API).

For example, clinical database 214 and 216 may be implemented as fault-tolerant, relation, expansible, safe database or its Any combinations, such as Oracle or Sybase.Clinical database 214 and 216 can include the various frameworks based on its realization.It is clinical Database 214 and 216 can use such as array, hash, chained list, structure, record, structured text file (for example, XML), The standardized data structures of table realize, or, clinical database 214 and 216 may be implemented as OODB Object Oriented Data Base (for example, using ObjectStore, Poet, Zope etc.).Clinical database 214 and 216 can use relation and unstructured number According to combination realize.Sometimes in the disclosure various treatment proxy modules discussed above, clinical database 214 and 216 can To be merged or disperse.It should be appreciated that any computer or database component can structurally and operationally be combined with any work And it is combined, merges or disperses.In one embodiment, data element can include and point to one or more additional databases Pointer, the redirection for thus introducing adaptive radiotherapy management system 400 are horizontal.For example, clinical database 214 and 216 can With comprising by the provenance graph of the data in the data correlation in a structure or system to another structure or system.By multiple This redirection of node cannot generally be observed by terminal user.

Fig. 4 is the functional block according to the exemplary adaptive radiotherapy management system 400 of some embodiments of the present disclosure Figure.System 400 can include treatment proxy module 210, medical treatment device 416 and 418, medical treatment device interface 420 and servicing unit 415.Treatment proxy module 210 can be operatively attached to medical treatment device 416 and 418.Medical treatment device interface 420 can be connected It is connected to and is configured to control medical treatment device 416 and 418 and servicing unit 415.Medical treatment device interface 420, medical treatment device 416, 418 and servicing unit 415 can be connected via device bus 422.

Medical treatment device 416, alternatively and medical treatment device 418, used in the radiotherapy that can be patient 426 any Device.In the exemplary embodiment, it is not necessary to medical treatment device 418, but if it does, it is different from medical treatment device 416.Example Such as, medical treatment device 416 can be brachytherapy afterloading unit, and device 418 is linear accelerator.In addition, medical treatment device 416 and 418 can include brachytherapy delivery system, brachytherapy US guides pin insertion system, gate is short Apart from radiotherapy delivering configuration, the brachytherapy device for being configured to predicting tracing delivery construct, afterloading unit, imaging dress Put, robot system, gamma knife, endoscopic apparatus, linear accelerator, combination MRI- linear accelerators etc..The He of medical treatment device 416 418 can be configured as from the treatment receive information of proxy module 210 and provide information to treatment proxy module 210.

According to some embodiments, medical treatment device 416 can include being used for the image and/or use for capturing patient anatomy The imaging device of function is formed in the one or more images for the large data sets for providing machine readable image information.It is for example, medical Device 416 can be CT scanner, PET scanner, MRI scanner, SPECT scanners or enter available for patient anatomy Any kind of device of row imaging of medical.

In other examples, medical treatment device 418 can be brachytherapy afterloading unit, and it is configured as：In response to The treatment for being promoted by treatment proxy module 210 or being made by treatment proxy module 210 determines, is received from treatment proxy module 210 Control command.

In other embodiments, medical treatment device 416 can be MRI scanner, and medical treatment device 418 is linear accelerator. Both via medical treatment device controller 414 receive from treatment proxy module 210 control command, and synergistically work with Analyze the view data obtained by medical treatment device 416, and the delivering that accommodation is implemented by medical treatment device 418.

Medical treatment device interface 420 can be configured as controlling medical treatment device 416 and 418 in the therapeutic process of patient 426. According to some embodiments, treatment proxy module 210 can receive input and be provided to user (for example, medical professional 424) Output.Medical treatment device interface 420 can be configured as acting on behalf of mould to servicing unit 415, medical treatment device 416 and 418 and treatment Block 210, which is sent, to be instructed and receives from it instructing.Medical treatment device interface 420 can be additionally configured to control and/or and servicing unit 415 communications.For example, medical treatment device interface 420 can be configured as providing control to treatment proxy module 210.

Servicing unit 415 can be one or more non-medical devices that non-medical function is provided to system 400.For example, In some respects, servicing unit 415 can perform various " service " algorithms, such as time determinability Monte carlo algorithm, pa tire out Support optimization, graphics processing unit (GPU) storehouse calculated for quickly performing great amount of images reconstruction etc..Servicing unit 415 can be with From treatment proxy module 210 and/or the receive information of medical treatment device interface 420 and provide it information.Treating proxy module 210 can With using servicing unit 415 perform it is described herein any one or more calculation procedure.

Treatment proxy module 210 can include adapted treatments engine 212, and can include one or more clinical numbers According to storehouse 214.Clinical database 214 can include multiple databases, including case database 600, protocol database 700 and appoint Business database 800, this will be discussed in further detail below.Clinical database 214 can provide to adapted treatments engine 212 Information simultaneously receives from it information.

Adapted treatments engine 212 can draw including medical treatment device controller 414, integration engine 412 and workflow coordination Hold up 410.Adapted treatments engine 212 can be configured as in the device being operatively connected (for example, imaging device is (for example, medical treatment Device 416)) in perform definition activity.In certain embodiments, adapted treatments engine 212 can parse clinic in real time Database 214 is (for example, in the present context, mean to hold during gradation is treated while using treatment engine 212 in real time Row parsing) determine the correlation between mass data collection and in view of the particular case by parsing data place acquistion Collect and candidate's agreement and/or agreement fragment and task are determined in the universe of option.For example, adapted treatments engine 212 can Whether it is substantially similar to deliver the correlation during gradation by using treatment portioning come the case for determining to run into before (for example, in terms of kinematics and/or structure collection element, such as relative position and size), and adapted treatments engine 212 can determine the best approach to present case.In other embodiments, adapted treatments engine 212 can be coordinated by controlling Treat the various therapeutic processes that proxy module 210 manages.Treatment proxy module 210 can be configured as the clinic based on dynamic change Situation (for example, reaction of the patient to particular treatment during portioning is treated) optimizes the behavior of system 400.In some instances, Adapted treatments engine 212 can be configured as with clinical response and efficacy information continuous updating clinical database 214 for Future clinical treatment.

Adapted treatments engine 212 can based on be stored in clinical database 214 mass data (such as diagnosis letter Breath) automatically access, analyze and plan treatment plan.For example, after parsing case database 600 and protocol database 700, Adapted treatments engine 212 can be with：(obtained via medical treatment device controller 414 in this case based on diagnostic message And by integration engine 412 and the medical image of processing), to determine that (for example, via processor 302) specific protocol is being examined Consider can effectively reach in the case of being determined from medical image specific clinical target probability be 94%.For example, even if for example should Agreement prediction should reduce the dosage to target due to the possibility to OAR overtreatments, and medical image be able to may also be disclosed in not While compromise to the OAR of surrounding dosage, it is suitable for providing the anatomical structure (example of extra radiation therapeutic dose to target Such as, the change of bladder/intestines/rectum filler).By this way, adapted treatments engine 212 can provide clinical decision branch Hold, this will allow in terms of the estimated dosage delivered of the various elements (for example, OAR and/or target tumour) to structure collection and/or pin To it is various consideration options intended results in terms of, compare applied to same patient geometry it is different it is optional treat mode it is pre- Count curative effect.Adapted treatments engine 212 can with medical imaging analysis to distinguish that clinically significant data point is used for cross-correlation, And the specific association for parsing clinical database 214 even to be used in the works across the prior treatment of different patients in same patient Possible correlation is found between other examples of view, other described examples show positive in the case of the given determination from image Tumor response (such as contraction).It is related to candidate's agreement to determine that adapted treatments engine 212 can access assignment database 800 Clinic can allow task and qualified authoritative (for example, medical professional 424) specific agreement, as more for what is compared A part for individual treatment option.Therefore, adapted treatments engine 212, which can be configured as analyzing coming from, is stored in such as case number of cases According to the data in the ever-increasing filing of the related data in storehouse 600, protocol database 700 and assignment database 800, so that Performed largely relatively (such as thousands of, millions of etc.) with processor 302, it is clinical admissible so as to be provided for patient 426 Business.Adapted treatments engine 212 can be about within some moment (for example, in seconds, such as between 1 to 10 seconds) Perform these exemplary actions.It is in any case possible to perform action in the time range of practicality.Practicality depends on knot The value of fruit is for waiting the balance of its cost.

In certain embodiments, adapted treatments engine 212 can perform in real time diagnostic message (for example, view data, Protocol comparison, task dependencies etc.) a large amount of comparisons, and select the clinic for patient 426 using comparing with correlation Excellent treatment option.According to some embodiments, adapted treatments engine 212 can be provided just to medical professional 424 The correlation of acquistion or the collection with the comparable treatment of readable format during the treatment of progress, it is determined that given observing and During the clinical setting of record the effect of candidate's agreement, and after being delivered into patient 426 determine treatment the effect of.At one In example, adapted treatments engine can be by the suitable data structure (example in curative effect cross reference to clinical database 214 Such as, the data structure being discussed in greater detail on Fig. 6, Fig. 7 and Fig. 9).

Adapted treatments engine 212 can include such as SVMs (SVM), Adaboost/Logitboost, random The learning algorithms such as forest, deep learning and/or neutral net and other.In some instances, adapted treatments engine 212 can be with Faced by the new correlation study made from the data being incorporated in treatment proxy module 210 to improve it with the passage of time Bed is intelligent.

By this way, medical professional 424 can be from by the acquistion of adapted treatments engine 212 and the information remembered Be benefited.Medical professional 424 can also be by system 400 and another doctor's (not shown) with the shared letter of significant form Breath, another doctor is in patient of the treatment with the analogue that may point to specific protocol.No matter the second doctor whether with Date treatment identical patient 426 afterwards, or different patients of the treatment with substantially similar physiological status or situation simultaneously, Second doctor can use the knowledge of institute's acquistion to benefit patient (for example, in real time).

Fig. 5 shows showing according to adaptive radiotherapy 500 (for example, the treatment of cancer) of some embodiments of the present disclosure Example property method.

In step 512, adapted treatments engine 212 can input in response to user and initialize new case.For example, doctor The radiotherapy for being designated as patient 426 and initializing that is there is provided by medical treatment device interface 420 can be received by treating Setup Controller 414 Instruction.Adapted treatments engine 212 can access case database 600 to create case history, as described below.In some implementations In example, treatment engine 212 can be determined to select the data required for agreement and it also requires medical image.Therefore, Treatment engine 212 can initialize " importing " task.

In step 514, diagnostic message is imported.In certain embodiments, medical treatment device controller 414 can be from medical treatment device 416 retrieval view data (not shown).For example, medical imaging apparatus 416 can perform one or more image processing operations with The image of patient is obtained, is then conducted into by medical treatment device controller 414.Importing task can be stored in assignment database A task in multiple tasks in 800.Integration engine 412 can contemplate from the diagnosis for importing and analyzing view data acquistion Information, medical treatment device configuration 724 is accessed from protocol database 700, and/or perform one from assignment database 432 or more Multitask, to prompt and receive user's input.In other embodiments, the combination of more than one data set/mode can be used To obtain the balance view on the case.

According to some embodiments, the view data that adapted treatments engine 212 can analyze importing clinically has to distinguish Information.Specifically, processor 302 can perform one or more treatment use data 320, and it can be visited during analysis Ask reference data (for example, the data included in one or more in database 600,700 and 800).Those skilled in the art It should be appreciated that adapted treatments engine 212 can import various medical images and/or other diagnostic messages (for example, all Such as blood or other liquid testings, radiological examination, the clinical data of biopsy).While characterized as embodiment Any specific analysis to medical image and/or diagnostic message is not indicated, it will be appreciated that the analysis for importing medical image can be with Including the known analysis of any one well known in the art and conventional or more kind.For example, graphical analysis can be included automatically Draw profile, segmentation, the analysis of " Dynamic constrasted enhancement " data set, physiological reaction assessment and other analyses.

In step 516, adapted treatments engine 212 can select more than first treatment agreements from clinical database 214, Medical image and reference protocol data wherein based on importing perform the selection.

In step 518, adapted treatments engine 212 can be with view of agreement selected by clinical target use formulates first Treatment plan.According to some embodiments, form that adapted treatments engine 212 will be readily understood that is to medical professional 424 Multiple options are presented, the form being readily appreciated that is merely provided for making the necessary information of clinical decision.For example, by adaptability The thousands of or even millions of individual machine-readable data points that treatment engine 212 considers can be extracted as a number of factors, such as dosage Uniformity, tumor control probability, Normal Tissue Complication probability, to the bioequivalence dosage of structure, result uncertainty etc., and And it is shown on output device 305.The task requests that adapted treatments engine 212 can perform instruction treatment plan selection are defeated Enter, and user's input is received via input unit 304.The input can indicate that the treatment to patient 426 determines.According to some Embodiment, medical professional 424 can the allowing adaptation to property treatment selection treatment agreements of engine 212.For example, the clinical rule received Specific protocol in selected agreement can be then linked to the intended treatment result of patient, and selected protocol suite can To provide enough bases for the link.

In step 520, adapted treatments engine 212 can be based on medical treatment device configuration 724, quality guarantee guide 722, (multiple) Clinical target 630 and/or 632 and other data are determined so as to assess intermediate data.When selected agreement is via medical treatment When device 416,418 and/or servicing unit 415 are delivered to patient 426, intermediate data can be by adapted treatments engine 212 Collect and/or generate.

In step 522, adapted treatments engine 212 can select individual candidate more than second based on the assessment to intermediate data Agreement.

In step 524, adapted treatments engine 212 can formulate second based on more than selected second individual candidate's agreements Treatment plan.Conception can select more than two optional treatment plans.

In step 526, adapted treatments engine 212 can by more than second individual desired treatments of candidate's agreements selection (for example, Second treatment plan) and submit (commit to) selection (for example, delivering treatment).

Fig. 6 is depicted according to the exemplary adaptive radiotherapy case databases 600 of some embodiments of the present disclosure Block diagram.Case database 600 can include more case records, including case history 602,610 and 612.Case history can be with Include the data set for the snapshot for representing the patient information related to clinical treatment (for example, a kind of situation).These snapshots are referred to as " mould Type node ".Model node can be included clinical target (for example, medical professional is the target of particular treatment setting) with suffering from The information of person (for example, patient 426) connection.The data that case history can also collect medical treatment device controller 414 and clinic Target is associated, it would be possible to clinical treatment with deliver treatment it is associated, and will deliver treatment result with by treatment act on behalf of The specific protocol that module 210 performs is associated.In several ways, case history can be represented as case develops (for example, working as When selection, delivering treatment and observation result) overview of the differentiation of the patient information related to clinical treatment.According to some implementations Example, case history can be stored in case database 600.

Although depict three records for case database 600 in this example, but it is to be understood that case database 600 can include any amount of case history.Case database 600 can be NoSQL/ figures/Object Library, example Such as, Orient DB or Neo4J.Case database 600 can also be another type of database schema known in the art.Case Example record 602 can include three general categorys of case data, including adaptability case data 608, continuation case data 604 and patient data 606.For example, the structure of case history can be directed acyclic graph.

Patient data 606 is the continuation record associated with patient (for example, patient 426), and can include patient The data structure of personal information 642, financial information 640, preclinical medical history 638 etc..Patient data 606 can with particular patient Shared parallel and maintenance in associated more case records.For example, if case history 602,610 and 612 is to be related to patient 426 all cases, then patient data 606 may reside in all three situations record in.Although patient data 606 is depicted For with data structure 638,640 and 642, but it is to be understood that extensive a variety of patient datas are generally associated with patient's record. For example, although being not shown, patient data can include the extra biological and other information associated with patient 426.

Case history 602 can also include continuation case data 604.Case describes one implemented to patient 426 Or more treatment process.The case data of continuation can be shared between more case records.For example, continuation case number of cases According to 604 treatment datas 636 that can include acquisition, it can include the prior treatment (example with being implemented by treatment proxy module 210 Such as, case, treatment portioning, radiotherapy etc.), and/or treatment (such as chemotherapy, operation) correlation of other systems and/or clinic The treatment data of connection.The treatment data 636 of acquisition can include data in itself or cover and be stored in case database 600 The link of continued therapy data, it can be associated (so as to another treatment) with another case.The treatment data 636 of acquisition is also Multiple links to prior cases record (such as case history 608 and 610) can be included, it can be drawn by adapted treatments Hold up 212 and carry out cross-correlation.

Continuation case data 604 can include coordinate system mapping 634, its provide coordinate system map information, including with spy Determine the uncertainty of the quantization of the data of mapping association.For example, data can be oriented from a point in system A space, And when the data from system A are converted to system B, difference in space can be directed it.Therefore, coordinate system Conversion between (for example, system A coordinate system and system B coordinate system) needs to know source coordinate, and needs to translate and revolve Turn that system B could be moved to from system A, vice versa.Each system can have specific quantization uncertainty business (such as not Certainty matrix).Therefore, one or more coefficient correlations can be associated with each corresponding preferred coordinates system mapping.One In individual embodiment, one or more coefficient correlations can include probabilistic quantization to coefficient.

Continuation case data 604 can also include the information on formalizing clinical target 632.The clinical mesh of formalization Mark can indicate the associated standard clinical target of the one or more clinical settings associated with case.If for example, Specific melanoma is successfully treated when test Q shows 3% or lower reading, then instruction " test Q 3% or less " The formalization clinical target of standard clinical target can be associated with continuation case data 604., may in another example The deviation of clinical target 632 for needing and formalizing.Continue example above, (warranted) can be permitted to expand on surveying Try the deviation of Q scope (such as 3% to 5.5%).When the deviation of the determination of medical professional 424 and standard clinical target is When necessary, clinical target deviation 630 can indicate the continuation record of deviation.Deviation record can be entered by integration engine 412 Row parsing and cross reference, to create significant correlation, treatment proxy module 210 is increased available using the correlation Knowledge base.

Continuation case data 604 with the continuation record comprising case is on the contrary, adaptability case data 608 can wrap It is contained in the data structure that may change during case.For example, adaptability case data 608 can include tasks carrying data 620th, protocol proposals data 622 and efficacy data 624.When tasks carrying data 620, protocol proposals data 622 and/or curative effect number During according to being changed, adaptability case data 608 can be replicated and/or changed.As described further below, adaptability case number of cases There is provided, and stored by task token input 614 and/or case token output 618 according to the link between 608 different records In case history 602.In other words, when the task of execution, the record and configuration and other control information (examples of event are performed Such as, it is intended that) it is saved together.In addition, it is also recorded for being supplied to any specifying information of task and the information of task return.Task Dependence between input and output data can be indicated by performing data 620, be enabled on being influenceed by Previous results Data carry out traceable identification (for example, provenance graph).So as to which case history 602 can be included with this interconnection information Many model nodes.

Tasks carrying data 620 can include the mission bit stream of task token form.Task token represents that case is specific The exchange of information (such as the continuation case data and patient data) information related to the information progress of case outside.Case Example space be by treatment proxy module 210 (for example, clinical database 214) safeguard data volume, and represent be managed it is (more It is individual) differentiation of case.During execution task, the information from case outside can be obtained, such as obtains image or connects Receive user's input.For example, treatment plan task may need to define the parameter of particular treatment machine.These machine parameters are present in , may be in another database (for example, clinical database 216) outside case space.For example, task token can include comprising The model node of the data of the part as acquired treatment data 636 previously obtained.With the development of case, adapt to Property treatment engine 212 can perform task and the execution of task is recorded as to a part for case history 602.What task was associated Data record can be immutable task token (for example, immovable stationary state) and/or modifiable task token.Example Such as, task token can be acquired, draw and preserve data set (CT scan, magnetic resonance imaging (MRI) etc.), one or more One or more formalization statements of more therapeutic purposes (such as dose prescription, dose volume histogram (DVH) requirement etc.), patient The observation (such as health status before gradation is provided, PSA (PSA) reading etc.) of state, and/or one The structure collection element (such as tumour, jeopardize organ (OAR) and delineate data etc.) of individual or more acquisition.

According to some embodiments, adapted treatments engine 212 can consult (reference) task token and input 614 (examples Such as, received task token), and produce case token output 618.Task token input 614 and case token output 618 The continuation that input and the output of information can be retained is recorded for index and cross-correlation, and it can increase adapted treatments engine 212 calculating speed.For example, in case history 602, should update efficacy data 624 (for example, perform treatment portioning it Instruction afterwards) can input in 614 the task token reflected to indicate by task token.In this case, adapted treatments Engine 212 can replicate in case history 602 and store adaptability case data 608, while be come using fresh information more newly appointed Business token input 614.Then, adapted treatments engine 214 can replicate and change adaptability case data 608 so that on record There is the instruction that efficacy data 624 is have updated using fresh information in example token output 618.By this way, previous adaptability Case data 608 be indexed and with the current cross-correlation of adaptability case data 608.Therefore, case history 602 can include several The model node of link.

Adaptability case data 608 may further include the information of the treatment protocol proposals on candidate therapeutic agreement. The therapeutic process that the treatment agreement specifically discussed in further detail below is made up of one or more tasks.Treat protocol proposals The one or more treatment agreements for being used to treat in the future proposed by adapted treatments engine 212 can be included.Protocol proposals number According to 622 (for example, information related to protocol proposals) and can be by adapted treatments engine with treating protocol-dependent task 212 are indexed and cross-correlation, so as to the record of the available treatment option of any set point being maintained in treatment time axle.

Efficacy data 624 can record the continuation record of specific protocol or the validity of other treatment option.For example, such as Fruit adapted treatments engine 212 selects agreement A, B and C, and delivers treatment C (for example, predicted treatment C is maximally effective), then Adapted treatments engine 212 will can be recorded in efficacy data 624 the effect for the treatment of C.According to some embodiments, adaptability is controlled Database 600 can be parsed by treating engine 212, and treatment C is related to the environment progress around agreement A, B and C selection, and will The effect for the treatment of C is related to the progress of these particular cases.For example, for treatment of brain tumor, to the dosage of optic nerve selected Agreement A, B and C between may be different, if other result related datas are acceptable, dosage choice can be based on most Favourable agreement.Therefore, efficacy data 624 can include the information relevant with case history 602, such as the specificity of patient 426 Information, and linking for the case token associated with other patient's (not shown) can also be covered.

Instruction in response to initializing case, integration engine 412 may search for case database 600 to determine whether there is The patient data 606 of the patient.If patient data 606 be present for patient 426, adapted treatments engine 212 can be created Case history 602 is built, and patient data 606 is associated with case history 602.Adapted treatments engine 212 can also open One or more attachments of a task are moved to prompt the patient information that input is additionally required.For example, adapted treatments engine 212 can be true Determine the date of birth that patient data 606 lacks patient.Adapted treatments engine can prompt medical professional 424 to input patient Date of birth (DOB).Therefore, adapted treatments engine 212 can record case token output 618, and its record is defeated to user The request entered.Adapted treatments engine 212 can receive input, enter data into and be saved in patient data 606, and logger task Token input 614.By this way, the index and correlation between the change in case history 602 are kept.

Fig. 7 is depicted according to the exemplary adaptive radiotherapy protocol databases 700 of some embodiments of the present disclosure Block diagram.Protocol database 700 can store agreement record 702,704 and 706.Protocol database 700 can include any quantity Agreement record.Protocol database 700 can include being used for agreement record 702 and the data structure with reference to protocol data 710.Example Such as, protocol database 700 can be the case administrative model and symbol (CMMN) type for the database that such as Camunda TM are realized Database.Protocol database 700 can also utilize other database architecture frameworks well known in the art.

The standard adaptation used in being included with reference to protocol data 710 specific to adaptive radiotherapy treatment of cancer The information of radiotherapy agreement.732 can be described including standard agreement with reference to protocol data 710 and describes to face with specific by standard Bed is intended to the clinical target mapping 730 that (for example, clinical target 632 of formalization) is linked.Adapted treatments engine 212 can be with By static protocol rule 725 and one or more particular task cross references from assignment database 800.If for example, control Treating the typical protocol of portioning includes the task from task record 802, then the information from the task record can assist in static state It is recorded and indexes in view rule 725 as task agreement mapping 726.The result quoted can also be in protocol results mapping 824 It is cited in the respective protocol record of protocol results mapping 728.

It can also include medical treatment device configuration 724 and quality guarantee guide 722 with reference to protocol data 710.Quality guarantee guide 722 can be with Indicate one or more quantitative guides of the agreement for being quoted in management agreement record 702.

Agreement record 702 can also include adaptability protocol data 708.Similar to adaptability task data 808, adaptability The agreement that protocol data 708 is updated in succession during being included in one or more cases by adapted treatments engine 212 Information.Agreement record 702 can include protocol proposals history and tasks carrying data 720, agreement curative effect record 716, agreement are inclined Difference record 714 and agreement deviation curative effect record 712.

Protocol proposals history and tasks carrying data 720 can include having been carried with agreement 702 associated agreements of record The record (for example, case history 602) of the case gone out.For example, when adapted treatments engine 212 from medical image based on drawing Diagnose to determine that agreement 702 is three kinds of suitable agreements being selected in the treatment motion to patient 426 a period of time, adapted treatments Engine may be referred to the information in protocol proposals history and tasks carrying data 720.

It is related that the agreement curative effect record 716 similar to efficacy data 624 can include the effect of associated with agreement 702 Information.When standard agreement changes (for example, deviation), it can be recorded in agreement deviation and record the deviation at 714.Therefore, when passing When sending deviation agreement, the effect of integration engine 412 can determine treatment, simultaneously records in 712 efficacy data.

Referring now to Fig. 8, according to some embodiments of the present disclosure, exemplary adaptive radiotherapy assignment database is considered 800 block diagram.Assignment database 800 can include multiple tasks record 802,804 and 806.Although assignment database 800 is described Three task records, it will be appreciated that any amount of task is stored in assignment database 800.

As it was previously stated, task is the preservation step of process (for example, workflow), such as obtains and preserve acquired data Collect, make therapeutic purpose formalization, determine patient's states, obtain one or more structure collection elements, control medical treatment device to implement Portioning treatment etc..Task can include single step (for example, input scanning), or can include multiple steps (for example, prompting User input data, import data, recorded database, by X it is associated with Y, Y is sent to medical treatment device controller 414 Deng).Each task can be stored in assignment database 800 as task record 802.

Task record 802 can include adaptability task data 808 (description below) and refer to task data 810.With reference to Task data 810 can include the standard associated with the adaptive radiotherapy with usual unmodifiable setting task and appoint Business.For example, can include the setting being adjustably controlled for medical treatment device 418 with reference to task data 810, it is in radiotherapy Context in only there is a security setting." should adjusting control ", task can be saved as static task rule 820.

Clinic of the task that information in static task rule 820 can include generally implementing with generally performing task for it Association between target.For example, the clinical target of " if implementation portioning " is always associated (for example, " X " of course with task X It is any particular task), then adapted treatments engine 212 can index and record the association as clinical task-target mapping 826.When adapted treatments engine 212 selects specific protocol, the one or more tasks associated with the agreement can be with office It is indexed in business-agreement mapping 822.The data associated with task result can be recorded in protocol results mapping 824, If for example, task Y (for example, " Y " is different particular tasks) when specific protocol is used together statistically with 80% Success rate is associated, then can record correlation as protocol results mapping 824.

Compared with it can be allocated to the normalisation rule of particular task with the reference task data 810 associated, task note Record 802 can also include adaptability task data 808.Adaptability task data 808 can include tasks carrying data 814, its It can be changed according to the experience of the acquistion of adapted treatments engine 212.For example, when adapted treatments engine 212 it is determined that adjusting During with one or more tasks, adapted treatments engine 212 can index the pass between particular task and the ambient conditions of needs Connection carrys out calling task.The related information can be saved as a part for tasks carrying data 814.For example, in simple scene Under, adapted treatments engine 212 can know medical treatment device 418 use information L, B and J to determine result.Adapted treatments are drawn Hold up 212 " can obtain task L ", " obtain B " and " the specific feelings of medical treatment device 418 may be needed to use with instruction by obtaining J " Condition is associated.For example, in some brain tumors, can indicate to use proton dose delivery apparatus, and some MRI may be needed Data plan the delivering of proton dose exactly.According to some embodiments, adapted treatments engine 212 can be based on causing to make With the former example of the specific environment of medical treatment device 418 (for example, task obtains L, obtains B and obtains J) come determine in view of this Plant the presence of particular case and the medical treatment device may be needed, and create the clinical task-target associated with task record 802 The record of association in mapping 826.The previous case of particular case can be saved as task token input 816.It is related to example The metadata (for example, one group for the treatment of considered is intended to) of connection can also be saved as task token input 816.Show as another Example, case token output 818 can include the metadata associated with indicating the specific cases of known mission bit stream.Curative effect Data 812 can record the case result associated with the mission bit stream known.For example, efficacy data 812 can point to case The distinctive efficacy data 624 of example, the execution as known task and the execution on clinical target it is relatively successful between Cross-correlation.If specific cases (for example, case history 602) include and the deviation of the clinical target 632 of formalization, the information It can be linked and indexed by efficacy data 812, to provide available information for the following application of adaptability task data 808.

Fig. 9 depicts the illustrative methods for being used to select more than first individual clinical protocols according to some embodiments of the present disclosure 900 flow chart.

In step 902, adapted treatments engine 212 can determine clinic first based on the information from medical image analysis Target.If for example, the certain types of tumour near medical image, other diagnostic messages instruction skin surface, clinical mesh Mark can be measurement tumour and provide enough dose of radiations so that tumor size is reduced into 80%.

In step 904, the diagnosis and/or analysis that integration engine 412 can be based on medical image are from assignment database 800 Select available agreement task.For example, integration engine 412 can determine diagnose L, and access static task rule 820 with from The one group of specific task (such as 11,12 and 14) of determination of task-agreement mapping 822 is suitable for diagnosing L.Integration engine 412 can be with One or more agreements are determined using available task 11,12 and 14.The determination that integration engine 412 is made can be by agreement The information that is accessed in database determines.

In step 906, integration engine 412 can select candidate's agreement for output based on available task.Can be with base Available task is selected in static task rule 820, static task rule 820 provides agreement (example in task-agreement mapping 822 Such as, agreement record 702) be directed to the clinically-acceptable various tasks of the agreement between linking.Integration engine 412 can pass through The result of each candidate's agreement is predicted further to analyze selected agreement.

In step 908, integration engine 412 can predict the clinical effectiveness of selected agreement (for example, predicting each agreement Meet the degree of the clinical target).Integration engine 412 can be based on include continuation case data 604, patient data 606, Adaptability case data 608, the available information with reference to protocol data 710 and/or adaptability protocol data 708 carry out real-time estimate knot Fruit.For example, prediction can be based on and the effect of associating (correlation) data 624 of protocol proposals data 622, agreement deviation curative effect record Other records of 712 similar informations absorbed with instruction from protocol proposals history and tasks carrying data 720.

In step 910, integration engine 412 can generate the agreement for selection.In view of the clinical target 632 of formalization And/or clinical target deviation 630, agreement can be generated based on the relative prediction made in step 908.

Figure 10 shows the illustrative methods for being used to assess intermediate data 1000 according to some embodiments of the present disclosure Flow chart.

In step 1002, integration engine 412 can be true from the clinical target 632 and/or clinical target deviation 630 of formalization Determine clinical target.

In step 1004, treatment proxy module 210 can perform one or more tasks to analyze intermediate data.

In step 1006, integration engine 412 can determine whether to meet clinical target from analysis.If clinical target obtains Meet, then need not carry out accommodation to treatment plan.

In step 1008, if target is not yet met, adapted treatments engine 212 can determine whether to change Become clinical target.If (for example, therapeutic purpose does not meet simply, but target is appropriate) treatment engine need not be changed 212 may not change clinical target.If necessary to change clinical target, then new clinical mesh can be prompted by treating engine 212 Mark.According to some embodiments, treatment engine can independently produce fresh target and record the clinical target 632 of formalization.

Figure 11 depict show according to some embodiments of the present disclosure be used to select more than second individual clinical protocols (for example, As described in step 522) illustrative methods 1100 flow chart.

In step 1102, adapted treatments engine 212 can determine clinical intention.According to some embodiments, integration engine 412 it is contemplated that the diagnostic message known from the importing and analysis of intermediate data (for example, step 522), from protocol database 700 access medical treatment device configuration 724, and/or perform from one or more tasks of assignment database 432 to determine clinical meaning Figure (for example, carry out cancer radiation therapy to realize certain measurable target, apply radiation with certain (may be limited) amount, So that the size of tumour is reduced into measurable amount, the change that can be measured with realization by clinical test etc.).

In step 1104, integration engine 412 can be based on the diagnosis and/or analysis of medical image come from assignment database The 800 available agreement tasks of selection.For example, integration engine 412 can determine diagnose M, and access static task rule 820 with Determine that a specific group task (being referred to as task 11,12 and 14) is suitable for diagnosing M from task-agreement mapping 822.Integration engine 412 still can determine one or more agreements using available agreement task 15,16 and 12.Made by integration engine 412 Determination can be determined by the information accessed in protocol database 700.

In step 1006, integration engine 412 can select candidate's agreement for treatment based on available task.Can be with base Available task is selected in static task rule 820, static task rule 820 provides agreement in task-agreement mapping 822 Linking between (for example, agreement 702) and the clinically-acceptable various tasks of the agreement.Integration engine 412 can be by pre- The result of each candidate's agreement is surveyed further to analyze selected agreement.

In step 1108, integration engine 412 can predict the protocol results of selected agreement.Integration engine 412 can be based on Including medical treatment device configuration 724, continuation case data 604, patient data 606, adaptability case data 608, with reference to agreement The available information of data 710 and/or adaptability protocol data 708 carrys out real-time estimate result.For example, can be based on and protocol proposals The effect of data 622 associated (for example, related) data 624, agreement deviation curative effect record 712 and instruction from protocol proposals with going through Other records of the similar information that history and tasks carrying data 720 absorb are predicted.

In step 1110, integration engine 412 can generate the agreement for selection.In view of the therapeutic purpose 632 of formalization And/or clinical target deviation 630, the agreement of generation can be based on the relative prediction made in step 1108.

Figure 12 is the flow chart for showing the adaptive radiotherapy according to some embodiments of the present disclosure, and can be used System 400 is realized.

In step 1210, medical treatment device controller 414 can import the biological structure that instruction is observed in patient 426 Medical image.Medical image can be provided by medical treatment device (for example, medical treatment device 416 and 418).For example, medical science into As device 416 can provide medical image (for example, cat scan) from the reception signal of adapted treatments engine 212.Imaging of medical Device 416 can perform the scanning to patient 426, and scan data (medical image) is saved in into local storage, and Adapted treatments engine 212 is transmitted data to via device bus 422.

In step 1212, integration engine 412 can perform and/or the execution of initialisation image processing is to analyze view data To determine the topology of the structure in data (topography).

In step 1214, after with reference to case database 600, protocol database 700 and assignment database 800, integrate Engine 412 can select more than first treatment agreements for describing structure.

In step 1216, adapted treatments engine 212 can select more than first treatment agreement and candidate's agreement is presented To medical professional.

In step 1218, adapted treatments engine 212 can independently or the approval through titular medical professional Determined to make treatment.

In step 1220, treatment goes through and is delivered.

In step 1222, the treatment based on delivering receives treatment data.For example, it can receive relevant with the treatment delivered Efficacy data.Efficacy data can include the information penetrated etc. on tumor regression, to the OAR width delivered.

In step 1224, treatment proxy module 210 can analyze intermediate result, and determine to need adaptability second to control Treat.

In step 1226, adapted treatments engine 212 can be based on using with reference to protocol data and adaptability protocol data More than second is treated agreement to select to jeopardize organ (OAR) and the second treatment plan targetted for determination.

In step 1228, the second selected treatment plan goes through.

In step 1230, treatment is made again and is determined.

In step 1232, the second treatment plan is delivered.Treatment proxy module 210 can be configured as managing various adaptability Radiotherapy, for example, including dose prescription and approval and dose delivery and record and other.

Figure 13 depicts manages treatment plan 1300 according to the exemplary adapted treatments of some embodiments.For example, selecting Select individual candidate's agreement 1216 more than first with initialize be used for determination jeopardize organ (OAR) and targeting delineate task after, adaptation Property treatment engine 212 can via output device (for example, output device 305 and/or medical treatment device interface 420) come present choosing .Various agreements (for example, clinical target, purpose and/or treatment option) 1302,1304,1306 and 1308 are depicted, its is each With the respective portioning plan (for example, 1310) that shows is connected with line with its respective task 1318.Adapted treatments engine 210 can by provide all four options relatively in a manner of present each agreement (for example, treatment option) 1302, 1304th, 1306 and 1308.Although being not shown, agreement 1304,1306 and 1308 can include the agreement knot similar to agreement 1302 Structure, but with the different tasks to be presented from 1302 comparable form of agreement.

Figure 14 shows the adaptive radiotherapy management agreement 1302 according to some embodiments of the present disclosure.In step 1402, agreement 1302 can include being used for the obtaining data of the task.After data are obtained, agreement 1302 can be performed in parallel Three tasks 1404,1406 and 1408.For example, 1404, agreement 1302 can obtain display mesh including the use of imaging device Mark one or more images of tumor's profiles.1406, agreement 1302 can include the drawing the profile that jeopardize organ of the task. 1408, giver (applicator) and/or conduit further can be applied to patient 426 by agreement 302.Although task 1404 Need to ratify with 1406, but some tasks (for example, task 1408) can be run in the case of without approval.1410, Task 1404 and 1406 is approved or declined.1412, agreement 1302 can include for reverse dose plan task (including Profile).1414, reverse dose plan goes through, and agreement 1302 can terminate.

According to some embodiments, agreement 1302 can be repaiied from its standard agreement description (for example, standard agreement describes 732) It is changed to include new task 1416 and 1418.Therefore, agreement may deviate standard description.Agreement 1302 can recorded deviation association Discuss deviation record 714.After the agreement of delivering deviation, the effect of adapted treatments engine 212 can determine agreement, and will Curative effect is recorded in agreement deviation curative effect record 712.As shown in figure 14, should although the step of agreement 1302 includes specific quantity Work as understanding, agreement 1302 is only exemplary.Treatment proxy module 210 can include any amount of clinically-acceptable treatment Agreement, it can include any amount for the treatment of task (with any amount of certain order).

The present disclosure describes the adapted treatments management system with individual treatment modeling and Workflow Management engine.It is shown The step of going out is intended to explain shown exemplary embodiment, and it is intended that the development of ongoing technology will change execution The mode of specific function.It is to illustrate and not limit to propose these embodiments herein.In addition, describe for convenience, The border of functional module is arbitrarily defined.As long as the function and its relation specified are duly executed, and are used The combination function of this group of module at family covers the requirement of application field, then can define and substitute border.Based on what is be contained herein Teaching, (including the equivalent of those described herein, extension, modification, deviation etc.) is substituted for the technology people of correlative technology field Member will be apparent.Such replacement is fallen into the scope and spirit of the disclosed embodiments.In addition, " including (comprising) ", " having, ", " including, ", " including (including), " and the word of other similar types are intended to meaning On be equivalent, and be open, because one or more after any one in these words are not intended to pair These or multinomial exclusive list, nor being intended to be only limitted to the item or multinomial listed.It must further be noted that as herein and Used in appended claims, singulative " one (a) ", " one (an) " and " being somebody's turn to do (the) " include plural, remove Non- context is otherwise expressly specified.

In addition, one or more computer-readable recording mediums, which can be used for realization, meets embodiment of the disclosure.Calculate Machine readable storage medium storing program for executing refers to that the information that can be read by processor or any kind of physics of data can be stored thereon deposits Reservoir.Therefore, computer-readable recording medium can be stored for the instruction by one or more computing devices, including for The step of making computing device meet embodiment as described herein or the instruction in stage.Term " computer-readable medium " should be understood that It is to include tangible item, and excludes carrier wave and transient signal, be i.e. non-transitory.Example include random access memory (RAM), only Read memory (ROM), volatile memory, nonvolatile memory, hard disk drive, CD ROM, DVD, flash drive, magnetic Disk and any other known physical storage medium.

It is intended that and is considered merely as the disclosure and example to be exemplary, the real scope and spirit of the disclosed embodiments As indicated by appended claims.

Claims (23)

1. a kind of system for producing treatment plan, the system includes：

Clinical database, it is used to store treatment agreement, wherein each treatment agreement reflects multiple treatment tasks；With

Engine is treated, it is operatively coupled to the clinical database, and the treatment engine includes：

Medical treatment device controller, it is configured as obtaining diagnostic message；And

At least one processor, it is programmed to：

More than first treatment agreements of selection from the clinical database, wherein the selection based on acquired diagnostic message and With reference to protocol data, wherein the treatment efficacy information for including renewal with reference to protocol data；

Using described more than first treatment curative effect probability for treating each agreement in agreement are calculated with reference to protocol data；

Based on clinical target, described reference agreement data and the treatment curative effect probability, from more than described first treatment associations View formulates the first treatment plan；

During first treatment plan is performed, assess instruction and change due to performing the process of first treatment plan The intermediate data of the patient's states of change；And

The second treatment plans are selected based on agreements are treated using more than second with reference to protocol data and adaptability protocol data, wherein Based on the clinical target, it is described with reference to protocol data and it is described treatment efficacy information to the second selected treatment plan Carry out accommodation.

2. system according to claim 1, wherein at least one processor is further programmed to：

Update case history, wherein the renewal include more than described first treating agreement, more than the second individual agreement, it is described in Between data and second treatment plan.

3. system according to claim 1, wherein at least one processor is further programmed to：

The effect of determining second treatment plan；And

Generate agreement curative effect record.

4. system according to claim 1, wherein at least one processor is further programmed to determine adaptability The clinical target for the treatment of of cancer.

5. system according to claim 1, wherein assessing the intermediate data includes：

It is determined that clinical be intended to；And

Assess on the clinical intermediate data being intended to.

6. system according to claim 1, wherein the diagnostic message includes one or more medical images.

7. system according to claim 1, wherein producing more than described first treatment agreement includes：

It is determined that clinical be intended to；

Generate multiple allowed protocol tasks；

At least two agreements are selected from protocol database based on allowed protocol task；

The result of each in selected at least two agreement of prediction；And

Based on result generation more than the first treatments agreement predicted.

8. system according to claim 7, wherein the protocol action that the instruction of the multiple allowed protocol task allows.

9. system according to claim 7, wherein, it is described more to generate based on the diagnostic message and the clinical intention Individual allowed protocol task.

10. system according to claim 9, further comprise wherein assessing the intermediate data：

New clinical intention is optionally produced based on the intermediate data.

11. system according to claim 10, wherein generating individual agreement more than described second includes：

Produce more than second individual allowed protocol tasks of the protocol action that instruction allows；

At least two agreements are selected from protocol database；

Predict the treatment curative effect probability of each at least two selected agreements；And

More than the second individual agreement is generated based on the treatment curative effect probability.

12. system according to claim 11, wherein based on the intermediate data and it is described it is clinical be intended to it is described new It is clinical be intended in one at least two agreement is selected from protocol database.

13. a kind of computer implemented method for being used to produce treatment plan, methods described include：

More than first treatment agreements are selected from clinical database using at least one processor, wherein the selection is based on diagnosis Information and with reference to protocol data, wherein including the treatment efficacy information of renewal with reference to protocol data；

The clinical target of the treatment plan is determined using at least one processor；

Using at least one processor, using every in more than first treatments agreements with reference to protocol data calculating The treatment curative effect probability of individual agreement；

It is general based on the clinical target, the reference protocol data and the treatment curative effect using at least one processor Rate, the first treatment plan is formulated from more than described first treatment agreements；

During first treatment plan is performed intermediate data, the centre are assessed using at least one processor The patient's states that data instruction changes due to the implementation procedure of first treatment plan；And

Using at least one processor, assisted based on being treated with reference to protocol data and adaptability protocol data using more than second View selects the second treatment plan, wherein based on the clinical target, described with reference to protocol data, diagnostic message and described controlling Treat efficacy information and accommodation is carried out to the second selected treatment plan.

14. computer implemented method according to claim 13, further comprises：

Update case history, wherein the renewal include more than described first treating agreement, more than the second individual agreement, it is described in Between data and second treatment plan.

15. computer implemented method according to claim 13, further comprises：

The effect of determining second treatment plan；And

Produce agreement curative effect record.

16. computer implemented method according to claim 13, wherein assessing the intermediate data includes：

Assess the intermediate data on the clinical target.

17. computer implemented method according to claim 13, wherein generating more than described first treatment agreement includes：

Generate multiple available agreement tasks；

At least two agreements are selected from protocol database based on the available agreement task；

The result of each at least two selected agreements of prediction；And

Based on result generation more than the first treatments agreement predicted.

18. computer implemented method according to claim 17, wherein the multiple available agreement task instruction is permitted Perhaps protocol action.

19. computer implemented method according to claim 17, wherein, based on the diagnostic message and the clinical mesh Mark to generate the multiple available agreement task.

20. computer implemented method according to claim 19, further comprise wherein assessing the intermediate data：

New clinical target is selectively generating based on the intermediate data.

21. computer implemented method according to claim 19, wherein generating individual agreement more than described second includes：

Produce more than second individual allowed protocol tasks of the protocol action that instruction allows；

At least two agreements are selected from protocol database；

The result of each at least two selected agreements of prediction；And

More than second individual agreements are generated based on prediction result.

22. computer implemented method according to claim 21, wherein described at least two from protocol database Agreement is come selection based on one in the intermediate data and the clinical target and the new clinical target.

23. a kind of non-transitory computer-readable storage media, its storage can be performed suitable by least one computing device The instruction of the method for answering property treatment of cancer, methods described include：

More than first treatment agreements of selection from the clinical database, wherein the selection is based on diagnostic message and with reference to agreement Data, wherein the treatment efficacy information for including renewal with reference to protocol data；

It is determined that the clinical target for the treatment of；

Using described more than first treatment curative effect probability for treating each agreement in agreement are calculated with reference to protocol data；

Based on clinical target, the reference protocol data and the treatment curative effect probability, from more than described first treatment agreements Formulate the first treatment plan；

During first treatment plan is performed, assess instruction and change due to performing the process of first treatment plan The intermediate data of the patient's states of change；And

The second treatment plans are selected based on agreements are treated using more than second with reference to protocol data and adaptability protocol data, wherein Based on the clinical target, described with reference to protocol data and the treatment efficacy information is counted to selected second treatment Draw and carry out accommodation.